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97 Cards in this Set
- Front
- Back
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Acute Epiglottis |
Age 2-7 years, High Fever Stridor, Sitting forward and upright. Chin up, mouth open, and drooling. Tx Ampicillin- Vaccinate against Hemophilus type B |
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Acute Epiglottis Anesthesia |
Requires immediate intubation - awake no NDMR, - extubation after leak test |
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CROUP or Laryngotracheal Bronchitis |
Younger - 6 months to 6 years Low Grade Fever Subglottic narrowing Barking Cough accounts 80% of kids with stridor Slow onset Common Cold -Viral causation |
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Treatment for CROUP or Laryngotracheal bronchitis |
Cool humidity, oxygen, racemic epi. (2.25% epi in 3ml NS is given at 0.05ml/kg up to 0.5ml/kg repeat 1-4 hours) Doesn't require intubation majority of the time. - only if PaCO2 is climbing |
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Omphalocele |
Base of the umbilicus within the umbilical cord Sac or covering is the amnion multiple anomalies associated trisomy 21 etc no closure if inspiratory pressure 25-30 and intragastric pressure greater than 20 |
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Gastroschisis |
lateral to umbilicus amnion - prevent hypothermia, infection and dehydration. Requires urgent repair |
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Anesthesia for Omphalocele and Gastroschisis |
decompress stomach w/ NG tube before induction No N2O Muscle relaxant to place bowel into abdominal cavity. keep intubated 1-2 days hydrate Balanced Salt solution and albumin |
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Intestinal Malrotation and Volvulus |
spontaneous abnormal rotation of the midgut around the mesentery. acute or chronic bowel symptoms Midgut Volvulus is a true surgical emergency Bilious vomiting, metabolic acidosis, |
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Intestinal malrotation and volvulus - anesthesia concerns |
NG decompress stomach OR quickly High risk for aspiration |
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Pierre Robin Syndrome |
Cleft palate Small face, glottis, jaw, tongue, and palate chin displaced posteriorly glossoptosis tongue obstructs airway |
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Treacher-Collins- Syndrome |
small mouth, facial, and pharyngeal hypolasia facial mouth deformity choanal atresia ear malformation* cardiac defects More severe than Pierre Robins |
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Anesthesia concerns with Pierre Robins Syndrome and Treacher-Collins Syndrome |
Intubation very difficult use awake technique Fully awake before exutbation |
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Trisomy 21 syndrome - Down's Syndrome |
Short neck, irregular dentition, MR, hypotonia, brachycephaly, micrognathia, high arched palate, macroglossia, tongue enlarges after birth, AO instability flat occiput, dysplastic ears, mongoloid slanting, brush field spots, strabismus |
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Cystic Fibrosis |
hereditary disease (autosomal recessive) thick viscous secretions and decreased ciliary activity, Increased residual volume and airway resistance with decreased vital capacity and expiratory flow rate |
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Anesthesia concerns with Cystic Fibrosis |
Anticholinergics are controversial deep intubation - so you don't stimulate secretions aggressive suctioning avoid hyperventilation aggressive resp therapy - (bronchodilators etc) |
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Scoliosis |
Lateral rotation and curvature of the spine and deformity of the thoracic cage reduced PaO2 mismatching increase PaCO2 sign of worsening Reduced chest wall compliance elevated PVR from chronic hypoxia cause pulmonary hypertension and RV hypertrophy |
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Malignant Hyperthermia Treatment |
call for help IV dantrolene 2-3mg/kg (2.5 standard) repeated every 5-10 minutes - Max dose 10-20 mgturn off agents hyperventilatecool 15ml/kg IV iced saline Na Bicarb Maintain UOP - lasix or mannitol |
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Upper airway obstruction in peds tx
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elevate head, warmed humidified oxygen via mask RACEMIC EPI** corticosteroid Fluid restriction and diuresis |
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Neonate normal |
place in radiant warm, suction baby, HR 120-160, RR 30-60 Meconium aspirated - suction max 3 times |
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APGAR Scores what to do |
0-2 intubate and chest compression 3-4 temporary assisted ventilation 5-7 - stimulation and blood oxygen across face |
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Indications for positive pressure ventilation |
Apnea, HR less than 100, and Persistent central cyanosis on 100% O2 by mask |
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Positive pressure ventilation in a neonate |
Rate of 40 First birth 40 than after don't go higher than 30. |
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When should you a hear a leak with a ETT in a neonate |
small leak with 20 cm water pressure
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When do you do chest compressions in a neonate |
HR less than 60 HR less than 80 and not responding to +pressure ventilation cardiac compression at rate of 120 and depth of 1/2 to 3/4 inches |
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Normal BP in neonate |
1-2 Kg = 50/25 3Kg = 70/40 |
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Epi and Atropine dosing for Neonate |
0.01-0.03- mg/kg of epi 0.03 mg/kg atropine |
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If placing an nasotracheal tube how many CM should be added |
2-3 cm for nasotracheal tube |
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the hallmark of intravascular fluid depletion in neonates and infants is |
Hypotension without tachycardia |
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Patient with congenital diaphragmatic hernia what should the peak inspiratory airway pressure be? |
less than 30, but realistically less than 20 |
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Which inhalational agent has the same MAC for neonates and infants |
Sevo |
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Sizing ET tube in peds |
Age + 16 / 4 |
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Tube sizes by ages |
Premature 2.5 term infant 3 3 months to 12 months - 3.5 2 -3 yr - 4 to 4.5 |
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Anatomic Distance from teeth to cords and teeth to carina in premature vs 3 year old vs 10 year old vs 16 year old |
premature teeth to cords 7 and to carina 11 3 year old teeth to cords 9 and to carina 14 10 year old teeth to cords 10 and to carina 17 16 year old teeth to cords 12 and carina 20 |
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Give 4 reasons why newborns are difficult to keep warm |
loss heat b/c greater surface area to body weight ratio can't compensate by shivering limited subq fat limited stores of brown fat |
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newborns primarily produce heat by |
ANS produced non-shivering thermogenesis by metabolism of brown fat up to 2 years of age
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Best way to warm an infant |
Heat the room |
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Resting O2 consumption of an adult and infant |
Adult 3.5 ml/kg infant 7.0 ml/kg |
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list the 4 heart defects in Tetralogy of fallot |
VSD, right ventricular outflow obstruction (pulmonary stenosis, right ventricular hypertrophy, and overriding aorta
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name 3 right to left shunts |
TOF Pulmonary atresia w/ VSD, and patent foramen ovale |
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left to right vs right to left shunt and induction of anesthesia |
left to right will be faster right to left will be slower |
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what age is cleft palate usually repaired |
12-18 months |
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myelomeningocele what are concerns |
can't lay flat on back for intubation a sac is present on its back with meninges and neural elements |
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Spina bifida a what are they commonly allergic too |
Latex |
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what percent of organ function declines after age 30 |
1% of overall function decreases every year after 30 |
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post op delirium vs post op cognitive dysfunction in older adults |
delirium will occur immediately cognitive dysfunction - may not occur for weeks to months. |
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what happens to plasma cholinesterase levels in older men |
it decreases |
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whats the most sensitive indicator of kidney function in the older adult |
creatinine clearance, b/c creatinine is usually not changed b/c of decreased muscle mass |
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Albumin and alpha1-glycoprotein what happens to these in the older adult |
albumin decreases alpha-1-glycoprotein increases |
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two most important ANS changes with aging |
decrease response to beta receptor and an increase in sympathetic nervous system |
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aging intubating doses |
at 80 propofol 1.7mg/kg midazolam 0.02/0.03 mg/kg etomidate 0.2mg/kg |
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How to determine ideal body weight in women and men |
women height in cm - 105 men height in cm - 100 |
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BMI how to calculate |
body weight (kg) / height squared ( m squared) |
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whats consider normal, overweight, obese I, obese II, morbid obese, super obese |
normal 18.5-24.9 overweight 25-29.9 obese 1 - 30-34.9 obese 2 35-39.9 morbid obese > 40 superobese > 50 |
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Two types of distribution of fat |
Android (central or apple) - more CV dx Gynecoid (pear or peripheral) - less CV dx |
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Obese changes in respiratory system |
Decreased FRC and ERV (most sensitive indicator of the effect of obesity) FRC will eventually fall below closing capacity Restrictive dx breathing pattern rapid and shallow |
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only ventilatory parameter to show improvement in respiratory function in obese patients |
PEEP |
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Free floating DISS check value |
on back of gas machine each connection is indexed for a specific gas. |
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Wall pressure to the machine for gases |
set at 50psig |
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safety pin index air, o2, n2o |
air is 1 O2 is 2 N2O is 3 |
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first and second stage regulator |
all they do is reduce pressure. 1st stage pressure decreased to 45psig second stage if present decreased to 16 psig |
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oxygen flush valve |
O2 delivered directly to patient at a rate of 35-70 L/min, psig of 40-50 from wall or cylinder. |
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Pressure sensor shut off value or oxygen failure pressure device |
alarm sounds at 30 and shuts off nitrous oxide if O2 falls below 25/20. senses pressure not flow |
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what happens if the inspiratory value sticks open |
the expiratory limb will exhaust through the inspiratory limb - the ETCO2 waveform will become elevated |
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what happens if the expiratory value sticks open |
the inspired volume will not enter the ET but instead will by pass and exhaust through the expiratory limb. |
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Positive pressure relief valve vs negative pressure relief value |
positive will allow gas to escape from the system to the operating room if pressure builds in the system negative will allow gas from the O2 to enter if pressure becomes to negative |
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what happens if you tip the vaporizer |
liquid vapor will get into the vaporizer chamber and the carrier flow will carry more agent to the patient |
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High pressure parts of the gas machine |
hanger yoke, yoke block w/check valves, cylinder pressure gauge, and cylinder pressure regulators |
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intermediate pressure parts of the gas machine |
ventilator power inlet, poplin inlets, check valves, pressure gauges, flow meter valves, O2 pressure failure device, o2 second stage regulator, flush valve |
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low pressure (16 psi) parts of the gas machine |
flow meter tube, vaporizers check valves, and common gas outlet. |
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Free floating valves |
primary function of any free floating valve is to prevent gases from leaking out of the system. |
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ball and spring valve |
to permit gas flow after you have made a connection such as plugging lines into the wall. all or none valve you supply the energy (the connection) and it will work all or nothing depending on the connection. |
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diaphragm valve |
first and second stage regulators are the only valves like this in the machine. Reduce pressure! |
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who regulates medical gases |
FDA |
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who controls processes such as filling and manufacturing gas cylinders |
department of transportation |
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how often should gases be inspected |
5 years unless they have a special symbol then 10 years |
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O2 E cylinder pressure and L O2 H cylinder pressure and L |
E - 660L and 1900 psig H 6900 L and 2200 psig |
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N2O E cylinder pressure and L N2o H cylinder pressure and L |
E - 1590 L and psi 745 (tells you what liquid is left) H - 15800 L and psi 745 |
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what is the most abundant constituent in soda lime |
Calcium hydroxide (CaOH2) |
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How much Co2 can be absorbed by 100g of Soda Lime |
15L of Co2 |
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Mapleson system best with spont ventilating patient |
A>DFE>CB All dogs cane bite |
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Mapleson best with controlled ventilation |
DEF>BC>A Dead bodies can't argue |
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How to prepare to give anesthesia to an MH susceptible patient |
flush machine 100% O2 for 10 minutes breathing circuits and Co2 canister needs changed vaporizers should be drained and be removed |
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Air Pressure and capacity of E cylinder |
Air 1900 Psi and 625 L |
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7 cylinder markings that are required |
Regulatory body DOT serial # purchaser, user and manufacturer manufacturer manual and symbol retest date ten year test interval neck ring owners identification |
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Open breathing system |
no mask on face - open system |
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Semi open breathing system |
Mask on Face spont breathing inhales gas and room air no rebreathing, |
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Semi Closed breathing system
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Mask on face anesthetic gas in system - no room air what we use today |
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Closed breathing system |
gases are contained in the system and are not vented rebreathing of gases flow has to be 150-500 ml/min for physiological requirements* flow has to be 150-250 ml/min under anesthesia* unknown gas concentrations* |
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Most commonly used mapleson circuit used today |
The bain circuit which is a modification of the Mapleson D - Best for controlled ventilation |
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Post procedure preparation for next use of an LMA |
wash in dilute Na Bicarb Use Endozime to clean Autoclaving for sterilization Max use is 40 times |
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when fully inserted what does the LMA rest against |
the upper esophageal sphincter |
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LMA sizing guideliness |
5kg- 1 - vol 4ml 5-10 kg - 1.5 vol 7 ml 10-20kg - 2 vol 10 20-30 - 2.5 vol 14 30-50 - 3 vol 20 50-70- 4 vol 30 70-100-5 vol 40 100 above -6 vol 50 |
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Mallampati scoring |
1- see pillars and entire structures 2- see ulvula 3 only soft and hard palate 4 - hard palate only |
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Grading of Cormack |
Grade 1 - perfect view 2- see cords but not perfect 3 - only epiglottis - 4 nothing |
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LMA compared to ETT |
GOOD -LMA less invasive, less anesthetic needed, less tooth and laryngeal trauma, less laryngospasm and bronchospasm, BAD - High risk of aspiration, unsafe in obese, limits PPV, less secure airway, |
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BIS monitoring index guidelines for number |
100- awake 90-70 - sedation light to moderate 60-70- deep sedation 60-40 GA 40-10 deep hypnotic state 10 Flat Line EEG - Burst suppression |
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Pulse Ox is based off what law |
Beer-Lambert Law Red light absorbed by deoxyhemoglobin (660) Infrared light is absorbed by oxyhemoglobin (940) |
